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Controlling the symptoms of secondary breast cancer

The symptoms of secondary breast cancer mainly depend on where the cancer is in your body. If your symptoms are not well controlled, ask to see a symptom control nurse, or palliative care nurse. These nurses are often based in hospital palliative care teams or local hospices. They can help anyone who has cancer symptoms and needs advice. Your specialist, GP, or breast care nurse can refer you.

Pain

Many people with cancer don't have pain. But if you get pain, it can often be helped by cancer treatment. For example, an enlarged liver may cause pain in your right side or shoulder. The pain can be reduced by hormone therapy, chemotherapy, or biological therapy that shrinks the cancer in the liver. Bone pain from bone secondaries can be treated with radiotherapy or chemotherapy or with drugs called bisphosphonates.

If you have pain that is not controlled with cancer treatment, there are many painkillers available. Pain can usually be very well controlled. The first step is to tell your doctor or nurse that you have pain so that they can find the right painkillers for you.

Other symptoms

There are medicines and treatments that can help to control other symptoms such as

Who can help you

If your symptoms are not well controlled, ask to see a symptom control nurse, or palliative care nurse. These nurses are often based in hospital palliative care teams or local hospices. They can help anyone who has cancer symptoms and needs advice. Your specialist, your GP, or your breast care nurse can refer you.

Pain

If you get pain, it can often be helped by cancer treatment. For example, an enlarged liver may cause pain in your right side or shoulder. The pain can be reduced by hormone therapy, chemotherapy or biological therapy that shrinks the cancer in the liver. Bone pain from bone secondaries can be treated with radiotherapy or chemotherapy or with drugs called bisphosphonates.

If you have pain that is not controlled with cancer treatment, there are many painkillers available. Pain can usually be well controlled. With good pain control, most people should be able to be free of pain when they are lying or sitting. The first step is to tell your doctor or nurse that you have pain so that they can find the right painkillers for you.

Breathing problems

Breathing problems may be caused by cancer cells in the lung or fluid collecting around your lung. Fluid around the lung is called a pleural effusion. Doctors can treat it by draining off the fluid. If you have secondary lung cancer, you may also have a cough. There are medicines that can help to control a cough – ask your doctor or symptom control nurse.

Constipation

Your treatment has made you lose your appetite and you are not eating as much as usual

You are not able to move about as much as usual

Don't be embarrassed to ask for help with constipation. The longer you leave it the more problems it can cause. Fibre in your diet and plenty of fluids will help, but you may also need to take a laxative. Your doctor can prescribe one. Many hospital and community nurses know about constipation. Ask them to tell you how to prevent or relieve it.

It is important to know that if you have constipation with severe abdominal pain and vomiting, you should not take laxatives. Your bowel may be blocked. Contact your doctor or breast care nurse as soon as possible.

Sickness

Treatment for sickness depends on what is causing it. Some painkillers or cancer treatments can cause sickness. You will also feel sick if you are constipated. Again, it is a good idea to talk this over in detail with a doctor or nurse. Then, you can get the treatment you need. Some people find that ginger is a good natural remedy for sickness. Try eating stem ginger or crystallised ginger if you like it. Or slowly sip ginger beer or ginger ale.

High blood calcium levels

If you have cancer cells in your bone, the damaged bone can release calcium into your bloodstream. A high level of calcium in the blood is called hypercalcaemia and can cause

Sickness

Tiredness

Confusion

Irritability

If you have hypercalcaemia, you will need treatment from your specialist. You may have to spend a day or two in hospital to get your calcium levels down. You will be given a drug called a bisphosphonate. These medicines can help to control hypercalcaemia. They can be given by drip or as tablets. A drip helps to flush the extra calcium out of your system. Drinking plenty of fluids will help too, if you are able to.

Bone pain and weakened bones

Secondary cancer in the bones often causes pain. It can also make the bones weaker and more likely to break. If the bone breaks due to the secondary cancer cells it is called a pathological fracture.

Your specialist may suggest that you have drugs called bisphosphonates. As well as lowering calcium levels, bisphosphonates can help with pain from bone secondaries and help to prevent breaks in damaged bones. Bisphosphonates can be given by drip into the bloodstream or you may have bisphosphonate tablets to take at home.

Another type of drug treatment that can help to strengthen your bones is a monclonal antibody called denosumab (pronounced den-oh-sue-mab). It lowers the risk of fractures and helps to control pain. You have it as an injection just under your skin (subcutaneously).

Sometimes your doctor may suggest radiotherapy to treat secondary bone cancer. The treatment kills off the cancer cells. Over a few weeks, the bone starts to repair itself and gets stronger again.

If a bone is very weakened, you may need to have surgery to strengthen it. While you are under a general anaesthetic, the doctor puts a metal pin into the centre of your bone and may also fix a metal plate to the weak part of the bone. This holds the bone firmly in place. The pin and plate stay in permanently and you may also have radiotherapy to the area. You will need to be in hospital for a week or two after your operation. But you can usually get up and start walking around within a couple of days of your surgery.

Spinal cord compression

Spinal cord compression means pressure on the spinal cord that can occur when a secondary cancer weakens the bones of the spine. This stops the spinal cord nerves working normally and causes symptoms. The symptoms depend on which part of the spinal cord is compressed. It is a serious problem that needs to be treated as soon as possible.

The National Institute for Health and Care Excellence (NICE) has released guidelines that say your doctor should tell you if you are at risk of spinal cord compression. They should also tell you which symptoms to look out for. Treating spinal cord compression as soon as possible helps to reduce the risk of permanent damage to the spinal cord.

The first symptom is usually pain. As the compression gets worse it causes other symptoms that may include

Pain or tenderness in the middle or top of your back or neck

Severe pain in your lower back that gets worse or doesn’t go away

Pain in your back that is worse when you cough, sneeze or go to the toilet

Back pain that stops you from sleeping

Numbness, weakness or difficulty using your arms or legs

A band of pain down your arm or leg or around your body

Changes in sensation in a part of your body

Not being able to empty your bowel or bladder

Problems controlling your bowel or bladder

You should contact your doctor or specialist nurse straight away if you have any of these symptoms. Don’t wait to see if they get better and don’t worry if it is an inconvenient time, such as the weekend. You need to speak to your doctor or nurse as soon as possible. Your doctor or nurse may want you to go to the hospital straight away for a scan. Your local area will have health professionals who coordinate care for people with spinal cord compression.

Loss of appetite

Poor appetite is quite a common symptom. It can have a specific cause. Or it may just be that you are feeling too tired or fed up to bother eating much. You can have supplementary nutritional drinks if you can't face eating a proper meal. You can buy the drinks from a chemist and they are also available on prescription from your GP.

You may go off food while you are having treatments such as radiotherapy, chemotherapy or biological therapy. It helps to try to gradually build up your diet after your treatment is over if you can. It may suit you better to eat very small amounts more often. A large meal can look very daunting if you are off your food. You may prefer to eat snacks little and often rather than stick to set meal times.

Difficulty sleeping

Even when you feel tired you may find it hard to sleep. There are different reasons for this, including anxiety and having a lot on your mind. You may want to ask your doctor for sleeping pills. These can help to break a pattern of poor sleep and get you back into a better routine.

Tiredness and weakness

Extreme tiredness is one of the most common symptoms that people with cancer have. You can be tired for many reasons. You may have low energy because of

Your cancer

Your treatment

Difficulty eating

Difficulty sleeping

Tiredness can be very difficult to cope with. You will have good days and bad days. You may want to stay as active as you can, but try not to push yourself too much on bad days. It helps to pace your activity so that you have periods of rest in between.

You can ask your doctor or nurse if there is an exercise programme that would be suitable for you. You can also plan your activity so that you don't have to make unnecessary trips upstairs, for example. Keep a phone handset within reach, so that you don't have to get up to answer the phone.

Make your life easier in all the ways that you can. For example, you could use a shopping trolley rather than carrying shopping home – or better still, get someone to do your shopping for you or have it delivered.

More information about controlling symptoms

You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our breast cancer organisations page gives details of other people who can provide information about breast cancer and its treatment. Some organisations can put you in touch with a cancer support group.

If you want to find people to share experiences and tips with online, you could use Cancer Chat, our online forum.

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